Center for psychological assessment and consultation - Downtown Fredericksburg
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Paperwork and Forms

Assessment Forms:

If you are coming to see us for psychological, developmental, or educational testing, please bring the forms below to your initial meeting. We will be happy to discuss any questions or concerns about these forms with you on the phone or in person. 
Forms for All Assessment Clients:
CPAC HIPPA
File Size: 81 kb
File Type: pdf
Download File

CPAC Informed Consent
File Size: 74 kb
File Type: pdf
Download File

Additional Form for Children Under 18:
Info Form Child
File Size: 41 kb
File Type: pdf
Download File

Additional Form for Adults over 18:
Info Form Adult
File Size: 38 kb
File Type: pdf
Download File

Consultation Forms:

If you have scheduled a Consultation meeting, the forms below must be completed prior to your appointment. Please call us with any questions or concerns.
Forms for all Consultation Clients:
CPAC HIPPA
File Size: 81 kb
File Type: pdf
Download File

CPAC Informed Consent
File Size: 74 kb
File Type: pdf
Download File

Consent to Consultation
File Size: 38 kb
File Type: pdf
Download File

Credit Card Authorization Form:

The following form should be completed if you would like to use a credit card to pay for services:
Credit Card Authorization
File Size: 41 kb
File Type: pdf
Download File


Center for Psychological Assessment and Consultation, PC
510 Princess Anne Street, Suite 102
Fredericksburg, VA 22401
Phone: (540) 698-0003
​
Copyright 2017; All Rights Reserved
  • Home
  • Why CPAC
  • Services
  • Parent Consultations
  • About
  • Contact
  • Insurance & Payment
  • Forms
  • Teen Support Group